Medicaid talks resume; chances of passage increase

JEFFERSON CITY, Mo. -- With a deadline fast approaching, legislative leaders expressed new optimism Thursday that a deal could be struck on legislation revamping the state's Medicaid health care program for the poor

Negotiations among House and Senate members broke apart late Wednesday, with some suggesting that a special legislative session could be needed.

But the two lead negotiators -- Senate Majority Leader Charlie Shields and Rep. Rob Schaaf -- resumed discussions Thursday afternoon.

House Speaker Rod Jetton, R-Marble Hill, who seemed resigned to a special session earlier in the day, said there now was a 95 percent chance that a compromise could be reached.

The legislature must adjourn by 6 p.m. Friday. But lawmakers have less time than that to reach a deal on the Medicaid legislation. Under House rules, a final version of the legislation must be drafted and distributed in the chamber by the end of Thursday's legislative session in order for it to be considered Friday.

Missouri's Medicaid program is due to expire June 30, 2008. Fearing this year's legislation was in trouble, the House approved an amendment to a separate bill Thursday that would extend the Medicaid program through June 30, 2010, essentially buying lawmakers more time.

"To me, getting it right is more important than getting it done in the next 24 hours," said Rep. Ryan Silvey, R-Kansas City, who offered the amendment. That bill must return to the Senate.

The Medicaid overhaul is one of the priorities of Republican Gov. Matt Blunt, who insists it's critical to pass the bill this year. His proposal would rename Medicaid as "MO HealthNet" and place a greater emphasis on preventive health care.

A version passed last month by the Senate would create incentives for patients and medical providers to achieve healthy outcomes -- rewarding doctors with more money and patients with credits that could be applied toward such things as medical co-payments, over-the-counter drugs or health club memberships. The Senate version also would move the Medicaid program toward a more managed-care structure.

The House version passed last week scraps most of the incentive payments in favor of higher base payments to physicians and other medical providers. It would restore coverage of dental care and certain other health benefits that were cut for some Medicaid recipients two years ago. It would make less dramatic changes in the structure of the program but set up more legislative oversight of it.

The panel of five House and five Senate negotiators had been at odds about the basic philosophical approach to the legislation, much less many of its details. On Wednesday, Schaaf and Shields -- both Republicans from St. Joseph -- even sparred about whose worksheets to use as the basis for negotiations. That, at least, seemed to be resolved by Thursday afternoon.

Medicaid bill is SB577.